Caesarean section is a common method used to save high‑risk pregnant women and save the lives of mothers and children. In a pregnant woman with a mediastinal mass, the symptom of progressive shortness of breath and chest tightness during pregnancy is not specific. It is difficult to detect the mediastinal disease early because pregnant women usually do not have an imaging examination to avoid harming the fetus. The advanced stage of the disease combined with respiratory failure and mediastinal syndrome brings great risks and challenges to the anesthesia of cesarean section. In this case, a pregnant woman in the third trimester was admitted to the hospital as an emergency, complicated with obvious dyspnea and mediastinal syndrome. Emergency multidisciplinary consultation was conducted before surgery, and an effective respiratory and circulatory support program was established. During the operation, acute airway collapse was treated urgently while maintaining the stability of circulation, oxygenation, and electrolyte, which ensured the caesarean section. After comprehensive perioperative treatment, the mother and child safely passed the perioperative period and recovered, and were discharged from the hospital.